When Terri Foster's face slammed into the dresser at the nursing home where she worked, her life changed forever. The blow injured the frontal lobe of her brain, leaving her forgetful, depressed and barely able to communicate.

A year later, Foster still could not function. She lost her job as a nurse's aide, she was unable to do simple chores at home and her stuttering prevented her from having meaningful conversations. Her family suffered too. Her husband mourned the loss of the woman he had married, and her 10-year-old son couldn't understand why his mom never wanted to get out of bed.

Foster knew she needed help, but she wasn't getting it from doctors. It wasn't until she began therapy at the Speech, Language and Hearing Clinic within the Department of Communication Sciences and Disorders that she truly began to heal.

According to Gordon Blood, professor and head of the Department of Communication Sciences and Disorders, the clinic provides assessments and interventions for people with delays or disorders in hearing, language, fluency, voice, articulation and phonology, including those with severe speech impairments requiring augmentative and alternative communication. Such communication impairments, he said, may result from developmental delays, congenital disabilities such as mental retardation, hearing impairment, autism, cerebral palsy or acquired disabilities such as traumatic brain injury, strokes or Lou Gehrig’s disease.

The clinic also provides an opportunity for undergraduate and graduate students to get hands-on experience as well as a laboratory for faculty members to conduct research.

All graduate students in communication sciences and disorders are required to accrue clinical hours as mandated by the American Speech-Language-Hearing Association. Here, a graduate student works with a student at Sugar Valley Rural Charter School.

When Kyra Englert started kindergarten at Sugar Valley Rural Charter School in Loganton, Pa., she had difficulty pronouncing many of the letters in the alphabet—so much so that no one, other than her parents, could understand what she was saying.

Miranda Padilla, a second-year master's student, spent the spring 2013 semester working with children at Sugar Valley.

Image: Paul Hazi Photographer

Individual attention for patients

A child who can't pronounce the letter "L," a teenager who stutters, a stroke victim who can't find the right word, an older person who is hard of hearing. People come to the Speech, Language and Hearing Clinic for a variety of reasons, but no matter why they come, they are given individual attention and the highest quality, research-based care.

After suffering for a year, Foster finally began to feel hopeful about her situation when she started attending therapy sessions at the clinic.

"I was tired of people telling me they couldn't help," said Foster. "But when I finally went to the Penn State clinic, Connie (Constance Kossan, instructor in communication sciences and disorders) said she could help."

According to Kossan, the clinicians assess each individual who comes in, looking in particular for communication weaknesses as well as strengths.

"Often we are able to restore function, but when this is not possible we must help them compensate for the skills they've lost by capitalizing on their strengths," said Kossan. "For example, if a person has difficulty expressing himself through speech because of a stroke or head injury, while that person is working on improving his speech we may help him increase his use of gestures or writing."

Kossan and some of the other clinicians worked with Foster twice a week for three years.

"I would start sentences and not complete them, and I would stutter through all of it," said Foster. "Connie and the other clinicians helped me to slow down and finish each word and finish a thought. I got rid of the stuttering in just a few months. What was harder to deal with was the memory loss, but Connie helped me learn to take notes and make lists."

While she was in therapy at the clinic, Foster completed training to become a certified phlebotomist. She now works as a certified phlebotomist at Mount Nittany Medical Center, and she said if it weren't for the help she received at the clinic, she may still be lying in bed or even living in a nursing home.

"We like to look at each person holistically," said Kossan. "It's not just you and your disorder, it's you trying to cope and live your life."

Dan Silverman is another patient of the clinic who feels he has received the individual attention he has needed to cope with his hearing loss. In May 1987, Silverman, then a 52-year-old professor of history at Penn State, was in his office with a student. All of a sudden he began to shake. His body temperature quickly rose to 105 degrees Fahrenheit. He raced to the emergency room, where he immediately slipped into a coma. A week later, Silverman woke up, but the severe bout of meningitis he had suffered stripped him of much of his hearing.

"I didn't realize right away how my hearing had been affected," he said. "A friend of mine who knew how much I liked classical music brought me some cassette tapes and headphones. I put the headphones on and turned on the switch and all I could hear was this terrible jumble of noise. I couldn't tell whether it was Beethoven or the Beatles. It was just racket."

Since 1987, Silverman has been fitted for three pairs of hearing aids by clinicians in the Speech, Hearing and Language Clinic.

"The level of expertise is very high and I am confident they are fitting me with correct hearing aids," he said. "They are anxious to make sure I get the right hearing aids and that they are fitted and adjusted properly."

According to Judith Creuz, instructor and clinician, only 25 percent of people who could benefit from wearing hearing aids actually get them.

According to Judith Creuz, instructor and clinician, only 25 percent of people who could benefit from wearing hearing aids actually get them.

Many people try them but abandon them for various reasons, many of which could be fixed if they get the proper attention from an audiologist in fitting and adjusting them.

"Hearing aids are nothing like normal hearing, but they have come a long way in recent years," said Creuz. "They now work with a device called a streamer that can interface via Bluetooth with a cellphone or mp3 player or television. This streamer, for example, can help people with hearing loss to watch television with the rest of the family without having to increase the volume beyond the comfort level of others."

Creuz, herself, has worn a hearing aid in one ear since she was a child and lost part of her hearing after contracting mumps.

"As I learn more about hearing loss, I have realized that it affects me socially," she said. "I talk too much about myself which I've learned is a common characteristic of hearing impaired people. It's because when you talk about yourself you're controlling the conversation, so it's easier for you. I get annoyed with myself and think, 'Why didn't I listen more?' But now I know that it's a trait of hearing-impaired people."

Real-world experiences for students

Like Creuz, whose hearing impairment has influenced the way she interacts with others in social situations, Kyra Englert was beginning to alter her behavior as a result of her communication challenges. When Kyra started kindergarten at Sugar Valley Rural Charter School in Loganton, Pa., she had difficulty pronouncing many of the letters in the alphabet — so much so that no one, other than her parents, could understand what she was saying.

"She didn't talk much at school because she was afraid people wouldn't understand her; I felt so bad for her," said Misty Snook, Kyra's mother.

Following a speech/language assessment and consultation with Kyra's mother and teacher, Kyra began receiving speech/language therapy at school. Speech/language services at Sugar Valley — organized and supervised by Barbara Roberts, instructor of communication sciences and disorders — have been provided on a contract basis to the school since 2000 as a result of a law mandating that public schools provide support for children with disabilities.

According to Roberts, the clinic at Sugar Valley not only helps children, but it also helps graduate students in communication sciences and disorders (CSD).

"All graduate students are required to accrue clinical hours as mandated by the American Speech-Language-Hearing Association," said Roberts. "Most of our graduate students get some school experience at Sugar Valley before they go off campus. It fulfills their obligation of getting practical experience, and overwhelmingly I hear that they have enjoyed the experience."

Miranda Padilla, a second-year master's student, spent the spring 2013 semester working with children at Sugar Valley.

"I had only ever had the opportunity to work in an urban school setting and after working in a rural setting, I saw that many of the same issues in education and communication exist across so many different settings of diverse populations," Padilla said. "The experience has taught me that communication, speech and language services know no boundaries. Each student and his or her needs are so different; it is about connecting with that individual student and it is in working with his or her strengths that you achieve success."

Padilla worked closely with Kyra during her time at Sugar Valley.

"Kyra had such a unique and individual personality," she said. "When we first met, she was shy and extremely quiet, but by the end of the semester I had the opportunity to experience her sweet sense of humor and incredible work ethic. She was constantly driven to succeed and each week she improved. I saw how proud she was with how far she had come. By the end of the semester, her speaking was clearer and she was much more conversational."

"Barb and the students worked so hard with Kyra," Snook said. "Now you can pretty much understand everything she says. I've noticed she's way more comfortable. She'll talk all the time, even around people she doesn't know. And she doesn't have behavior issues anymore, whereas before she would get mad and upset when we couldn't understand her."

At Sugar Valley, Roberts and the students screen all incoming kindergartners for speech issues. "By age 3-1/2, kids should be reasonably well understood by people outside the family," said Roberts. "If they aren't, they could benefit from therapy." Currently, Roberts and the graduate students work with some 60 children at the school.

Back on campus, undergraduate students also gain experience from the clinic.

To prepare for graduate study in communication sciences and disorders, students must accrue 25 hours of clinical observation.

"This can be done in a variety of settings — for example in acute care settings, in the schools or in private practice — but the Speech, Hearing and Language Clinic is one excellent choice for them. We always encourage them to get a variety of experiences; for example, they could observe a speech-language pathologist in our clinic; in acute care, working bedside with people who have just had strokes or head injuries; in the schools, working with kids with developmental disorders; or in private practice. Undergraduates are required in the introductory class CSD 146 to come into our clinic and observe a therapy session and write a reaction paper."

A living laboratory for researchers

While the clinic helps patients get the care they need and helps students get the experience they need, it also serves as a living laboratory for faculty members to conduct research.

Sam (name changed to protectprivacy) was 5 years old when his parents brought him to the Speech, Hearing and Language Clinic. He had been diagnosed with PDD–NOS (pervasive developmental disorder not otherwise specified) — which is given to individuals with difficulty communicating and interacting with others but who do not meet the full criteria for a diagnosis of autism.

"Sam's communication was limited, and he became frustrated when his attempts to communicate were not understood," said Kathryn Drager, associate professor of communication sciences and disorders. "He could use about 10 words and a few signs, but the majority of his communication was through non-symbolic means, such as sitting in his dinner chair to indicate hunger or playing with the button on the remote to watch TV. He did not usually interact with his peers, and preferred to sit and watch them play."

Sam's parents brought him into the clinic for an AAC (augmentative and alternative communication) assessment, which is the term for the various tools and approaches used to enhance communication. Examples of AAC include word approximations, gestures, signs, communication boards with pictures and speech-generating computers.

"He was then referred to my research project, and his parents signed a consent form for his participation," said Drager. As part of the research project, we were able to trial a speech-generating device and then make a recommendation to his parents about what type of AAC device would be appropriate. If an AAC device is required, then some source of funding is needed. That can be from the families' personal funds, through their private health insurance, the school system or an agency such as Medicare."

Drager trialed a dynamic-display speech-generating device (SGD) that allowed Sam to interact with others using a variety of displays that he could access through a touch screen. These displays were primarily digital photos of the activities that he was involved in; for example, Drager took a photograph of him playing with a toy garage and programmed the device to say words and phrases when he touched certain parts of the image.

Sam’s expressive language significantly increased with the use of a high-tech voice output communication system and he demonstrated the ability to learn new symbols to be incorporated into his daily communication repertoire. The increased number of symbols gave Sam an opportunity to better express himself, and this would be beneficial to him by reducing frustration associated with communication breakdowns.

"We feel that the experience was beneficial for all parties," said Drager. "The clinicians were able to complete an assessment, but also see that the next steps were taking place and know that things didn't end with the report. And we were able to add a participant to our research study to help us answer what we felt was an important question. Most importantly, the child and his family received individual attention and specialized services."

According to Blood, the clinic serves as a wonderful opportunity to see a problem with a real human being and ask, "What can I do to help improve that person's life?"

"That's where the research ideas flow from," he said. "We start backwards with the long-term outcome and say, 'I would love to see this person able to function in the classroom, to be gainfully employed and to have a social network around her for the rest of her life.' That's where the research starts from, this long-term objective to enhance and improve the quality of people's lives."